[Congressional Record Volume 163, Number 77 (Thursday, May 4, 2017)]
[House]
[Pages H4139-H4149]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  PUBLIC HEALTH SERVICE ACT AMENDMENT

  Mr. BURGESS. Mr. Speaker, pursuant to House Resolution 308, I call up 
the bill (H.R. 2192) to amend the Public Health Service Act to 
eliminate the non-application of certain State waiver provisions to 
Members of Congress and congressional staff, and ask for its immediate 
consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. (Mr. Simpson). Pursuant to House Resolution 
308, the bill is considered read.
  The text of the bill is as follows:

                               H.R. 2192

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. ELIMINATION OF NON-APPLICATION OF CERTAIN STATE 
                   WAIVER PROVISIONS TO MEMBERS OF CONGRESS AND 
                   CONGRESSIONAL STAFF.

       If the American Health Care Act is enacted, effective as if 
     included in the enactment of such Act, section 
     2701(b)(5)(A)(ii) of the Public Health Service Act (42 U.S.C. 
     300gg(b)(5)(A)(ii)), as added by subsection (a) of section 
     136 of the American Health Care Act (relating to permitting 
     States to waive certain ACA requirements to encourage fair 
     health insurance premiums), is amended by striking 
     ``1312(d)(3)(D),''.

  The SPEAKER pro tempore. Pursuant to House Resolution 308, the 
gentleman from Texas (Mr. Burgess) and the gentleman from New Jersey 
(Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentleman from Texas.


                             General Leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and insert extraneous material on H.R. 2192.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, after 7 years, we have heard the stories from our 
constituents, from our patients, from our friends, from our families 
who have suffered under the Affordable Care Act. Today, we will have a 
chance to vote on a plan that will rescue and revitalize the market and 
lower costs and increase flexibility for patients to choose and keep a 
health insurance plan that works for them and their family. However, 
before we can do that, we have to pass a bill that will ensure that 
Members of Congress and their staffs are treated the same way as the 
rest of America.
  So let's be clear. We firmly believe that Members of Congress should 
live by the same rules as everyone else, period. The bill we are 
considering now will make a simple technical correction to ensure that 
the American Health Care Act and its amendments apply equally to 
everyone when signed into law.
  Over the last several months, we have worked thoughtfully and 
thoroughly with our colleagues in the Senate to achieve our shared goal 
of repealing and replacing ObamaCare. Throughout these discussions, we 
have come to better appreciate and better understand the other 
Chamber's reconciliation limitations. As a result, we have drafted the 
American Health Care Act with constant awareness of what the slightest 
misstep may mean for the legislation's privileged status or that 51-
vote threshold in the other body.
  Some might say it is easier for a camel to go through the eye of a 
needle than to draft House policy to Senate procedure, but we are 
confident that we have achieved that challenging feat.
  One of the limitations we have come to respect is that no committee 
other than the Senate Committee on Finance or the Senate Committee on 
Health, Education, Labor, and Pensions can receive a jurisdictional 
referral. For example, if we were to cross-reference multi-State plans 
established by the Affordable Care Act, we would get a referral to the 
Senate Homeland Security and Governmental Affairs Committee because 
those plans are under the Office of Personnel Management.

                              {time}  1115

  So let's be clear, congressional healthcare operates as a small group 
plan within the District of Columbia's SHOP Exchange. This was a 
decision that was made by the Obama administration.
  So for waivers impacting the essential health benefits of age rating, 
which impacts both the individual and small group markets, Members of 
Congress and our staffs would be treated the same. As far as community 
rating, this impacts only the individual market, so no group plans, 
including Members of Congress or our staffs, would be impacted.
  Even so, in an attempt to be crystal clear, today we are passing a 
bill, out of fairness and transparency, to ensure that Congress 
operates under the same laws as private citizens, a principle that both 
Republicans and Democrats should support.
  My thanks to Representative McSally for her leadership on this issue. 
Her bill helps deliver us a step closer to fulfilling our promise. 
Today we will fulfill our promise to provide relief from the higher 
costs and the dwindling choices for patients under the Affordable Care 
Act. Today we will repeal and replace ObamaCare with a better solution.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself 2 minutes.
  I remind my colleague from Texas that his vote for the healthcare 
bill will take away protections for 4,536,000 people with preexisting 
conditions in Texas.
  Mr. Speaker, I heard my colleague from Texas talk about repeal and 
replace. This is the myth, the hoax, that the Republicans and the 
President are trying to play on the American people. I assure you this 
is repeal. There is no replacement.
  The people are going to lose their insurance. They are going to pay 
more. They are going to have lousy insurance because they are not going 
to have any kind of protections.
  We passed the Affordable Care Act because the States were not doing 
the right thing. People couldn't afford insurance. They couldn't pay 
for a premium. They were too high.
  So what did we do? We expanded Medicaid, and we provided generous 
subsidies for those people who needed it.
  We also knew, under the old system where the States were in charge, 
that people got lousy insurance if they

[[Page H4140]]

could even find it. Sometimes they didn't have hospitalization, so we 
insisted there had to be a package that included preexisting 
conditions.
  We also said that, you know, if you were paying a lot for your copays 
or your deductibles, we are going to put limits on those things as 
well. And we put limits also on how much you can charge, what we call 
``community rating.''
  Now, what are the Republicans doing here today? They are getting rid 
of all that. They want to go back to the old days. And when they tell 
you that somehow they are going to be able to do this, the reason they 
can't do anything is because they repeal most of the pay-fors that pay 
for the subsidies that pay for the Affordable Care Act.
  So when they tell you: Oh, we are going to give extra money for this, 
for high-risk pools or to help the States if they decide to have 
waivers, the bottom line is there is no money left here. There is no 
money to pay for those subsidies; there is no money to pay for Medicaid 
expansion; there is not enough money to pay for high-risk pools because 
they have repealed the underlying pay-fors that we use to pay for the 
Affordable Care Act.
  What they are doing now is going back to the old system, the Wild 
West of the States. They are allowing States to waiver the essential 
benefits package. They are saying to States that they can charge 
whatever they want for the insurance because they got rid of community 
ratings.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PALLONE. Mr. Speaker, I yield myself another 15 seconds to say 
this: Do not buy into this hoax. There is no money left. They want to 
go back to the old system, and the old system stunk. What we did was 
correct the problems of the old system. So don't believe this cruel 
hoax.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Arizona (Ms. McSally), the author of the bill.
  Ms. McSALLY. Mr. Speaker, I rise today in support of my bill, H.R. 
2192, a measure that eliminates double standards by preventing Members 
of Congress from being exempt from the State waiver provisions of the 
American Health Care Act, as amended.
  Due to very arcane Senate procedural rules within the budget 
reconciliation process, the MacArthur amendment to the American Health 
Care Act does not and cannot apply to Members of Congress. To address 
this, I have introduced this simple, standalone, two-page bill that 
would appeal the exemption for Members of Congress should the American 
Health Care Act become law.
  In the military, the same code of conduct and standards apply to the 
entire chain of command. Now, in my role as a lawmaker, I believe that 
any law we pass that applies to our constituents must also apply 
equally to Members of Congress. Individuals who are stewards of the 
public trust must abide by the rules that they make. My bill, H.R. 
2192, will ensure that Congress abides by the laws they pass and is 
treated no differently than other hardworking Americans.
  Regardless of your vote on the AHCA, this is a bill that each and 
every single Member of Congress should support.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Arizona that her 
vote for this bill could increase premiums for people with breast 
cancer in Arizona by $42,250.
  I yield 1\1/2\ minutes to the gentlewoman from California (Ms. 
Eshoo).
  Ms. ESHOO. Mr. Speaker, I think that today is yet another sad day 
here in the House of Representatives for the people of our country, 
because what is being brought forward is the same bill that we debated 
and that went down because of the weight of the problems and the 
cruelty of that bill. It is the same thing with a few more poison pills 
in it.

  People are going to have to pay higher premiums and deductibles, and 
it is going to increase what comes out of their pocket; there is going 
to be less coverage; 24 million people will lose their coverage--that 
remains in this bill--and key protections are gutted, American people: 
emergency rooms, maternity care, opioid, mental health care, a string 
of things that you want in your insurance coverage, a crushing age tax 
for seniors.
  Now, there is a real hypocrisy here. Every single Member of Congress 
has been enrolled in the Affordable Care Act. I want to know which one 
of you dropped out of it. It was good enough for you--one person, 
great. Two people, big deal. It was good enough for you, but it is not 
good enough for your constituents.
  And you know what? Who is standing with you? Not the doctors in our 
country, not the AARP to seniors, not nurses, not the cancer 
association, not anyone. This bill violates the American people.
  The SPEAKER pro tempore. Members are reminded to direct their remarks 
to the Chair.
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Kentucky (Mr. Guthrie), the vice chairman of the Health Subcommittee on 
Energy and Commerce.
  Mr. GUTHRIE. Mr. Speaker, I rise today to urge my colleagues to 
support the American Health Care Act.
  A constituent of mine from Kentucky personally reached out to share 
her story. Under ObamaCare, the cost of her family's monthly premium 
rose to over $1,000 with a deductible of over $12,000, in total, almost 
half her income. When she fell and broke three ribs, she couldn't 
afford to go to the emergency room because of the astronomical 
deductible. She suffered for weeks until as she could afford care; and 
as she said in her own words: ``I paid 50 percent of my income for 
something I am forced to buy and cannot use.''
  In Kentucky, there are many counties with just one health insurer on 
the exchange. That is not right. Affordable health care means having 
real access to health care when you need it. ObamaCare reduces access. 
It is not there, when they need it, for many Americans.
  I urge my colleagues to support the American Health Care Act.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Kentucky that 
his vote for the healthcare bill will take away protections for 881,000 
people with preexisting conditions in Kentucky.
  I yield 1\1/2\ minutes to the gentleman from Texas (Mr. Gene Green), 
the ranking member of the Health Subcommittee.
  Mr. GENE GREEN of Texas. Mr. Speaker, it is appalling what is 
happening today on the House floor. It appears to be: let's just pass a 
bill, no matter what it does or who gets hurt with it.
  TrumpCare is nothing more than broken promises and mean-spirited 
policy. It would mean higher healthcare costs for more than 24 million 
hardworking Americans losing their health coverage, key protections are 
gutted, older Americans are hung out to dry, the end of Medicaid as we 
know it, and cuts in Medicare.
  If TrumpCare passes, Americans with preexisting conditions could be 
pushed off their insurance and sent in the high-risk pools that are not 
affordable. High-risk insurance pools do not work when everyone in the 
pool is a high risk. I was a State legislator when we did that. You 
have to have high-risk pools that share the wealth, so to speak.
  People will be left with soaring costs, worse coverage, and rationed 
care. It is a frightening future where millions of Americans who need 
affordable, dependable health care are left out in the cold.
  There is an obvious, irresponsible reason why this vote is being 
rammed through without even a Congressional Budget Office estimate or 
an opportunity for Members to even know what is in it. They don't want 
people figuring out the real-world consequences and the devastation it 
means to our American families. History will not be kind to the people 
who support this awful bill.
  I urge my colleagues to do what is right and vote ``no.''
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Olson).
  Mr. OLSON. Mr. Speaker, the Senate never quits. When ObamaCare was 
passed in 2010, the Senate Democrats refused to use ObamaCare for their 
personal insurance. Most Americans know that what is good for the goose 
is good for the gander. My staff, my family,

[[Page H4141]]

and I have been on ObamaCare since day one.
  Incredibly, the Senate is at it again. They don't want the American 
Health Care Act to apply to them because it is not right. They are 
special, and so they put a clause to exempt Congress from the American 
Health Care Act so they could filibuster the healthcare bill. That dog 
didn't hunt in 2010; it ain't hunting in 2017. If it is good for the 
American people, our bosses, it is good for their servants, Congress, 
us.
  I urge my colleagues to be true public servants. Vote for H.R. 2192.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Texas that his 
vote for this bill could increase premiums for people with diabetes in 
Texas by $5,100.
  I yield 1\1/2\ minutes to the gentlewoman from Colorado (Ms. 
DeGette).
  Ms. DeGETTE. Mr. Speaker, the American Health Care Act was pulled 
from the House floor in March because the American people realized it 
was a deeply flawed bill. That bill would have ripped healthcare 
coverage away from 24 million of our constituents.
  For those lucky enough to maintain coverage, the bill would have 
massively raised premiums, deductibles, and out-of-pocket costs. The 
crushing age tax in this bill would force older adults to pay 
astronomically high premiums.
  So what did the majority do in the last 6 weeks? They made the bill 
worse.
  The MacArthur amendment lets States opt out of the essential benefits 
of the ACA. Not only would this jeopardize insurance availability for 
the one-third of Americans who have preexisting conditions, it would 
let insurance companies deny coverage altogether for maternity, for 
emergency room, for mental health, and for other essential benefits. 
And because the MacArthur amendment eliminates community ratings, 
everybody's insurance costs would skyrocket.
  I am going to tell you something. My Republican colleagues are going 
to be really, really sorry that they rushed this bill to the floor 
before they got an amended CBO score. The reason is, when we do get 
this--and make no mistake, we will get this--they are going to find out 
that many more millions of people besides the 24 million people, 
originally, who are going to lose their insurance are going to be 
shocked to wake up to find out, if this TrumpCare bill passes, many 
millions more will lose their coverage.
  I urge a ``no'' vote on this poorly conceived legislation.
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Florida (Mr. Bilirakis), a valuable member of the Health Subcommittee 
on the Energy and Commerce Committee.
  Mr. BILIRAKIS. Mr. Speaker, I rise today in support of H.R. 2192 to 
ensure Members of Congress and staff are not exempt from the American 
Health Care Act. Making good on our word, this legislation will be 
passed alongside the American Health Care Act and fixes a technical 
error made to comply with the Senate rules.
  In our country, lawmakers are not above the law. Elected officials 
and the people we represent should have the same health care, period.
  As an original cosponsor of H.R. 2192, I believe this is common 
sense. It is straightforward legislation, and it is necessary as a 
companion bill to the American Health Care Act.

                              {time}  1130

  It is really quite simple: Congress should live by the same laws it 
creates.
  When the American Health Care Act becomes law, Members of Congress 
and staff will have the same health care as the American people. I urge 
passage of H.R. 2192, in conjunction with the American Health Care Act.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Florida that his 
vote for the healthcare bill will take away protections for 3,116,000 
people with preexisting conditions in Florida.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Pennsylvania (Mr. Michael F. Doyle).
  Mr. MICHAEL F. DOYLE of Pennsylvania. Mr. Speaker, for the past 7 
years we have had 62 votes to repeal the Affordable Care Act, but 
Republicans have never once put a plan on the floor for the American 
people. Well, today, we all get a chance to go on record of where we 
stand on this bill, this shameful, cruel bill.
  Here are the facts: 24 million Americans are going to lose their 
insurance if this bill becomes law. Over $839 billion gets cut out of 
the Medicaid program. The essential benefit package in States, wiped 
out. In my State, it is taking care of people with mental illness and 
opioid addiction; gone. This takes $117 billion out of the Medicare 
trust fund.
  This is a healthcare bill--this is really a tax bill masquerading as 
a healthcare bill. The plan here is to take this money out of the 
healthcare system and use it for tax cuts. That is what this bill is 
going to do.
  This creates a survival-of-the-fittest health care for America. If 
you are young, if you are healthy, if you are wealthy, this bill is for 
you; you are going to do okay. But if you are old, if you are sick, if 
you are poor, there is no coverage in this bill for you.
  If you have a young child with cancer, guess what, those benefits 
aren't going to be paid. You are going to run out of benefits.
  These high-risk pools are a sham. They are not adequately funded. 
This bill must be defeated. The American people will remember who votes 
for this bill today.
  Mr. BURGESS. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I wish to now speak to the underlying MacArthur 
amendment that the McSally bill is here to modify. The MacArthur 
amendment specifically would allow States to waive three of ObamaCare's 
costliest mandates. Let me stress that again. It would allow States--
not require States; it would allow States to waive three of ObamaCare's 
costliest mandates, essential health benefits, age ratings, and 
community rating.
  In waiving these Federal mandates, health insurers would not be 
allowed to discriminate by gender or preexisting condition, and no one 
would be denied coverage, period.
  Here is how it works: a State may apply to waive essential health 
benefits or to increase the age rating ratio from the bill's underlying 
5-to-1 ratio. They may also change the way individuals who have not 
maintained continuous coverage are charged for their healthcare plan, 
but only if the State has a risk-sharing program in place, like the 
Federal Invisible Risk Sharing Program established by the Palmer-
Schweikert amendment.
  In order to receive a waiver, a State must explain to the Secretary 
of Health and Human Services how the program will reduce average 
premiums for patients, increase enrollment for residents, stabilize the 
State's health insurance market, stabilize premiums for individuals 
living with preexisting conditions, or increase the patient's 
healthcare options.
  It is important to note that in providing assistance to reduce 
premiums or other out-of-pocket costs, for individuals who may be 
subject to an increase in their monthly premiums because they reside in 
a State with an approved waiver, have a preexisting condition, are 
uninsured because they have not maintained continuous coverage and they 
purchase health insurance on the individual market, there will be $138 
billion to assist with premium assistance.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. Mr. Speaker, understand this: the Republicans planned 
to exempt Members of Congress from the provisions of TrumpCare until 
they got caught.
  So here are five numbers that show just how deadly and dangerous the 
Republican bill is:
  Twenty-four million is the number of children, adults, and veterans 
whose health insurance will be ripped away.
  $880 billion is the size of the cut to Medicaid, threatening health 
care and long-term care for 74 million people: children, pregnant 
women, the elderly, and the disabled.
  $600 billion is the tax cut that goes to millionaires and 
billionaires and corporations.
  758 percent is the premium increase a 64-year-old making $26,000 a 
year will pay because of the Republican age tax.
  Seventeen percent is the percent of Americans who supported TrumpCare 
before they made it worse.

[[Page H4142]]

  The Republicans' attempt to improve TrumpCare is like trying to douse 
a dumpster fire with gasoline. This bill is a disaster, and anyone who 
votes for it does so at their extreme peril. The American people are 
watching, and they will not forget.
  Mr. BURGESS. Mr. Speaker, I would point out that within the State of 
Illinois, there were eight plans in 2015. There are five plans in 2017 
with a 57 percent increase in premiums.
  Mr. Speaker, I yield 1 minute to the gentleman from Ohio (Mr. 
Johnson), a valuable member of the Energy and Commerce Committee.
  Mr. JOHNSON of Ohio. Mr. Speaker, I thank the gentleman for giving me 
time to speak up.
  I, too, agree that Members of Congress should be subject to the same 
rules and laws that the American people are. So I support my colleague, 
Ms. McSally, in this legislation.
  But, you know, I want to speak to the bigger, broader issue here. My 
colleague from Pennsylvania said: What about that family with that kid 
that has cancer?
  Where was my colleague and the friends on the other side of the aisle 
when ObamaCare resulted in millions of policy cancellations and 
millions of Americans losing their coverage because of the broken 
promises?
  Where was my colleague and the Democrats when millions of Americans 
were forced out of work because of the job-killing policies of 
ObamaCare?
  Let me tell you something. The American people remembered that, and 
that is what happened in 2010.
  We didn't hide in a back room to get what we are doing today done. We 
have been working on it for 6 years, and we are going to get it done 
today. We are going to meet the promises that we made to the American 
people, and starting today, ObamaCare is on its way out the door.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Ohio that his 
vote for this bill will take away protections for 1,919,000 people in 
Ohio with preexisting conditions.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from North 
Carolina (Mr. Butterfield).
  Mr. BUTTERFIELD. So you have been working on it for 6 years. My 
information is that you posted this bill at 8 last night. The 
Congressional Budget Office has not given it a score. They have not 
told the American people how much it is going to cost or how many 
people it is going to affect.
  You have skyrocketed premiums for hardworking Americans who have 
preexisting conditions, and that is what my colleagues need to 
understand.
  If you are an average 40-year-old adult with a preexisting condition 
and have diabetes, it is estimated your premiums will rise $400 a 
month. If you have rheumatoid arthritis, $800 a month. And heaven 
forbid if you have some preexisting condition involving cancer; the 
numbers just go off of the chart.
  You know and I know this bill will not see the light of day in the 
Senate. This is a political stunt to save face with your rightwing 
base. You know it and we know it.
  If this wasn't so serious, affecting the economy and the 
affordability of insurance, I would say just go on and do it, because 
you will lose your opportunity to serve in this House and you will 
ultimately lose the majority.
  Don't do it. Forget about politics. Think about the 24 million 
Americans who will not be able to afford health insurance coverage.
  That is why the American Medical Association, AARP, American Nurses 
Association, and all of the other stakeholder groups have pleaded with 
you. They have called your office. They have written you letters. They 
have written us letters.
  Don't do it. I ask you to vote ``no'' on this ill-conceived 
legislation.
  The SPEAKER pro tempore. The gentleman and all Members are reminded 
to direct their remarks to the Chair.
  Mr. BURGESS. Mr. Speaker, directed to the Chair, I would just make 
note of the fact in North Carolina, there were three plans offered in 
2015, down to two plans in 2017, premium increase of 82 percent.
  Mr. Speaker, it is now my pleasure to yield 1 minute to the gentleman 
from Michigan (Mr. Walberg), another member of the Energy and Commerce 
Committee.
  Mr. WALBERG. Mr. Speaker, regardless of the myths being spun by the 
other side of the aisle that refused to read 129 pages of a bill, the 
Affordable Care Act is anything but affordable.
  My constituents have been asking for relief from this collapsing law 
for years. They can no longer afford to pay more for less; and refusing 
to act is not an option.
  Under ObamaCare, out-of-pocket expenses have skyrocketed not just for 
people on exchanges, but for all patients. Premium increases are nearly 
four times larger than previously projected.
  Unfortunately, our colleagues on the other side of the aisle, Mr. 
Speaker, seem content with the current flawed system which puts the 
government in charge of people's health and promises coverage that is 
going away.
  Let's vote to increase choice, lower costs, enhance protections, 
truly cover preexisting conditions, and get Washington out of the way 
so that patients and their doctors are once again at the center of 
healthcare decisions.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Michigan that 
his vote for this bill could increase premiums for those who are 
pregnant in Michigan by $13,790 per year.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from 
California (Ms. Matsui).
  Ms. MATSUI. Mr. Speaker, Republicans are turning their backs on the 
American people today. There are no guarantees with this bill. This 
bill will raise costs for families, penalize people nearing retirement 
with an age tax, and rip coverage away from millions of Americans.

  And if that wasn't bad enough, this revised TrumpCare bill guts 
protections for people with preexisting conditions; people like 
Cameron, who was diagnosed with cancer at 24 years old. Because of the 
Affordable Care Act, he was able to access coverage and attend graduate 
school. Now, of course, he has a preexisting condition.
  This is personal for Cameron and millions more in this country, and 
they are not going to be silent as Republicans rush this legislation 
through.
  Mr. Speaker, lives are on the line. I urge my Republican colleagues 
to have the courage to vote ``no'' on this legislation.
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Georgia (Mr. Carter), another valuable member of the Energy and 
Commerce Committee and a member of the Health Subcommittee.
  Mr. CARTER of Georgia. Mr. Speaker, I rise today to urge my 
colleagues to support the American Health Care Act.
  For the last 7 years, I have watched ObamaCare crush the healthcare 
system that I worked in for more than 30 years. Thanks to ObamaCare, we 
have an insurance exchange that has withered to where a third of the 
counties in our country have only one insurer. At home in Georgia, 96 
counties have only one choice on the exchange. That is not a choice.
  ObamaCare has failed, and the American Health Care Act is critical to 
resuscitate our healthcare system and move it in a direction where 
patients, families, and doctors are making decisions, not the Federal 
Government and bureaucrats sitting behind a desk in Washington.
  The American people need and deserve better, and that is why we must 
pass the American Health Care Act. This legislation guts ObamaCare and 
rebuilds a system that would deliver the choice and control that 
patients need and deserve all while ensuring that health insurers will 
not be allowed to discriminate by gender or preexisting conditions, and 
no one will be denied coverage, period.

                              {time}  1145

  Mr. PALLONE. Mr. Speaker, I remind my colleague from Georgia that his 
vote for the healthcare bill will take away protections for 1,791,000 
people with preexisting conditions in Georgia.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Florida 
(Ms. Castor), who is the vice ranking member our committee.
  Ms. CASTOR of Florida. Mr. Speaker, this bill will be devastating to 
families all across America. The Republican bill rips coverage away 
from millions of Americans. The last projection was 24 million. They 
didn't wait for the new

[[Page H4143]]

projection, which is going to be much higher.
  The Republican bill hurts Medicare, and it shortens the life of the 
Medicare trust fund just when we have more baby boomers retiring and 
calling on Medicare. It imposes a huge age tax because it makes 
affordable insurance much less affordable if you are about age 50 or 
older.
  A dirty little secret here that most people have not discussed is the 
harm it does to the Medicaid guarantee. For over 50 years in America, 
we have said that if you are disabled, if you have a family member with 
Alzheimer's, or if you have a child with a complex medical condition, 
you are not going to be destitute because your health care is so 
expensive. That is one of the fundamental guarantees of Medicaid for 50 
years. They take that away and go to the heart of the medical care that 
is provided under Medicaid as well. It is shameful.
  But it got worse. As we approach this day, they didn't have the 
votes, so they made it worse by going to the heart of the Affordable 
Care Act which ended discrimination against our neighbors with a 
preexisting condition.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Ms. CASTOR of Florida. They also said essential health benefits are 
not going to matter. What good is an insurance policy if you buy it and 
you can't go to the emergency room? We have got to vote ``no'' on this 
bill.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Ms. CASTOR of Florida. We have got to fight back against this crass 
power play that transfers all the wealth in this country. Vote ``no.''
  The SPEAKER pro tempore. The gentlewoman is no longer under 
recognition.
  The Chair would ask Members to respect the gavel and the time 
yielded.
  Mr. BURGESS. Mr. Speaker, I would point out that, in the State of 
Florida, there were 10 insurance plans available in the individual 
market in 2015, down to 5 plans in 2017, with a 24 percent premium 
increase.
  Mr. Speaker, I yield 2 minutes to the gentleman from New York (Mr. 
Collins), who is a very valuable member of the Energy and Commerce 
Committee.
  Mr. COLLINS of New York. Mr. Speaker, for the past 7 years, the 
American people have pleaded with their Representatives in Washington 
to repeal ObamaCare. Today, every Member of this body has the 
opportunity to do just that. We have the chance to eliminate 
excruciating mandates and taxes that are suffocating our economy and 
marketplaces.
  Under ObamaCare, premiums have increased by over 37 percent since 
2014, one-third of counties in this country have only one insurance 
provider, and 4.7 million Americans were kicked off the insurance 
coverage they wanted to maintain despite President Obama's promise 
that, if you like your healthcare plan, you can keep it.
  But today we have the chance to lower premiums, increase competition 
among insurance providers, and improve access to health insurance for 
all Americans. We finally have the chance to formally reject an 
unprecedented government overreach into health care and take the first 
step towards giving patients control over their own health.
  In western New York, this bill will have even more profound benefits. 
The amendment that I authored with Representative John Faso will 
relieve county governments in New York of a $2.3 billion unfunded 
mandate forced onto county taxpayers by the Governor of New York and 
will substantially reduce the tax burdens of property owners across New 
York State. This one provision of the American Health Care Act will 
save taxpayers in the eight counties that I represent over $470 million 
a year.
  This is a game-changer for local New York governments and restores a 
fundamental tenet of representative democracies that the level of 
government that makes the decision about spending should be responsible 
for raising those funds. I am proud to stand up for western New Yorkers 
whose voices have been silenced for too long, and I am proud to vote 
for the freedom, fiscal responsibility, and local decisionmaking this 
bill guarantees.
  Mr. Speaker, I urge all my colleagues to do the same.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from New York that 
his vote for this bill will take away protections for 3,031,000 people 
in New York with preexisting conditions.

  Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from New York 
(Ms. Clarke).
  Ms. CLARKE of New York. Mr. Speaker, I rise today in strong 
opposition to the American Health Care Act. This dangerous and 
destructive bill leaves 24 million Americans without coverage. It will 
cause the uninsured rate for my district in Brooklyn, New York, to 
skyrocket to over 12 percent and leaves over 400,000 Brooklynites in my 
district without coverage.
  Because of the severe cuts to Medicaid, this bill will also put 
people in the terrible position of having to choose between being able 
to eat, being able to obtain life-sustaining medication, or visiting 
their doctor.
  Which one do you, Mr. Speaker, suggest they choose?
  For most Americans, Medicaid benefits are not the end goal but, 
rather, provide temporary support. For seniors, Medicaid can mean the 
difference between nursing home care and dying alone.
  I urge my colleagues to consider the harmful and deadly real-life 
impact of this legislation, and I vehemently oppose it. I ask that we 
resist this cynical reverse Robin Hood sham that takes from the poor 
and gives to the rich.
  As President Lincoln said: ``You can fool some of the people all of 
the time, and all of the people some of the time, but you can't fool 
all of the people all of the time.'' This is a sham, and we need to 
vote it down.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Florida (Mr. Dunn), who is a very valuable Member of Congress and a 
fellow physician.
  Mr. DUNN. Mr. Speaker, I rise today, once again, in support of the 
American Health Care Act. I do this as a doctor for the good of my 
patients. We are here today to repeal ObamaCare, to take healthcare 
decisions away from Washington bureaucrats and give them back to the 
people.
  The American Health Care Act will create a patient-centered system 
that will lower the cost of health care and serve patients. This act 
eliminates ObamaCare's taxes, subsidies, and mandates. It defunds 
Planned Parenthood. It puts Medicaid on a budget, and it is the largest 
entitlement reform in a generation.
  Without Washington mandates driving up costs and limiting access to 
care, Americans will have the freedom to obtain quality healthcare 
plans that fit their needs at a cost they can afford.
  All this talk about preexisting conditions, this bill provides 
guaranteed issuance.
  Let's not break our promise on repealing ObamaCare. Let's be true to 
our word. We owe it to the people who sent us here.
  I support the American Health Care Act, Mr. Speaker, and I urge all 
Members to do the same.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Florida that his 
vote for this bill could increase premiums for people with asthma in 
Florida by $4,090 per year.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Massachusetts (Mr. Kennedy).
  Mr. KENNEDY. Mr. Speaker, what this legislation does on the surface 
is very clear: it makes health care more expensive. The more you need 
it--the sicker or older or poorer you are--the further out of reach it 
will be. That is why doctors, hospitals, nurses, the mental health 
community, and patients have spoken out, and spoken out against this 
bill.
  But this bill doesn't just cut coverage and hike premiums all for a 
tax cut for the wealthy. It codifies a worldview by this administration 
that is dead set on dividing America along the lines of the god of your 
prayers, whom you love, where you come from, and your fate and fortune. 
We see it in their tax plan, in their budget cuts, in immigration 
policy, and now in health care, a worldview that scapegoats the 
struggling and the suffering, that sees fault in illness, and that 
rejects the most basic universal truth of the human existence, which is 
that every single one of us one day will be brought to our knees by a 
diagnosis we didn't expect, a phone call we can't imagine, and a loss 
we cannot endure.

[[Page H4144]]

  So we take care of each other because, but for the grace of God, 
there go I one day, and we hope we will be shown that mercy, too. It is 
the ultimate test of the character of this country confronting our 
Chamber today: not the power we give the strong, but the strength with 
which we embrace the weak.
  Mr. BURGESS. Mr. Speaker, may I inquire as to the time remaining.
  The SPEAKER pro tempore. The gentleman from Texas has 13\3/4\ minutes 
remaining. The gentleman from New Jersey has 11\1/4\ minutes remaining.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Virginia (Mr. Griffith), who is a valuable member of the Energy and 
Commerce Committee.
  Mr. GRIFFITH. Mr. Speaker, this bill guarantees access for all. And 
when I say ``access,'' let me be clear: it is access for all.
  When you have insurance companies that are pulling out--today we 
learned Aetna is pulling out of Virginia--and when you have counties 
across these United States that no longer have anyone who is willing to 
provide the ObamaCare insurance, that is not access;
  When you have a situation where somebody comes up to you at the local 
county fair and says, ``You have got to get me out of ObamaCare. It is 
killing me. It is killing our family's finances because we have such a 
high deductible, because we have such a high copay, and my husband is 
very sick,'' he may have a piece of paper, Mr. Speaker, he may have a 
piece of paper, but it is not really health insurance when you can't 
really use it without having to sell off what little assets you may 
have or worry about whether or not you can afford to have a roof over 
your head any longer.
  This is not working. ObamaCare is not working. This bill will bring 
some sanity back to the system. It will take us a couple of years, but 
the rates of insurance will, in fact, come down.
  This business that we keep hearing that all these people are going to 
be without availability of insurance, it is just fake news. It is not 
true. This bill does everything that people want it to do, but it gives 
them choices--not mandates from the Federal Government, but choices--
about their health care.

  I have been interested to hear some people saying that you all are 
just ramming this through because the bill wasn't posted until last 
night. What wasn't posted until last night was the Long-Upton 
amendment, or the Upton-Long amendment. It is two pages. I invite my 
colleagues on the other side of the aisle to read it. The McSally bill 
is a page and a quarter. The MacArthur amendment, which has been out 
for over a week, is about 8 pages. They could have read it while we 
have been standing here debating this bill.
  But they don't choose to read the bill, they don't choose to learn 
the facts, and they don't choose to tell the American people the truth. 
They want to scare the American people to make them believe that this 
is a bad bill.
  This is a good bill, and I urge everyone to vote ``yes.''
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Virginia that 
his vote for the healthcare bill will take away protections for 
1,344,000 people with preexisting conditions in Virginia.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from California 
(Mr. Peters).
  Mr. PETERS. Mr. Speaker, I have seen this bill every step of the way 
over the short month we have considered it. I was there for the 26-hour 
meeting we had at the Energy and Commerce Committee. We didn't have an 
analysis from the Congressional Budget Office then either. If you want 
to accuse us of not wanting to know the facts, that is something that 
is very basic to know. We would like to have that here. Here we are 
again on the floor without that analysis.
  Through all of that time, the sad thing is that we have not heard one 
real argument for how this bill would make health care more affordable 
and accessible for families in my district in San Diego or anywhere in 
the country.
  Now, the healthcare system isn't perfect. There are problems with 
some insurance markets because they are not providing the choice they 
should. So let's fix them. But that is not what we are doing. What we 
are doing is we are on the cusp of passing a bill that is opposed by 
doctors, nurses, hospitals, patients, seniors, and just about everybody 
because it would make the problems in our healthcare system worse, not 
better.
  This is a bill that, if it were to become law, would rip health 
insurance coverage away from at least 24 million Americans. That is the 
Congressional Budget Office. That is not fake news. That is the truth.
  The bill would leave many Americans with preexisting conditions with 
premiums they can't afford or without any coverage at all.
  Today's votes take us one step closer to a system where families go 
bankrupt over an unexpected illness and our emergency rooms are filled 
with mothers once again seeking basic care for their children.
  I refuse to accept that is the best we can do for the American 
people, and I am voting ``no.''
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Tennessee (Mr. Roe), who is a fellow physician and the chairman of the 
House Veterans' Affairs Committee.
  Mr. ROE of Tennessee. Mr. Speaker, the American Health Care Act in no 
way changes the existing regulations that allow a veteran who is 
eligible but not enrolled in the Department of Veterans Affairs' 
healthcare system from using a tax credit to purchase health insurance. 
Language that would have codified that legislation into law was removed 
from an earlier version of the bill to comply with Senate rules.

                              {time}  1200

  Removing language in no way changes that existing regulation or a 
veteran's eligibility to receive a tax credit. By the way, that is the 
exact same language that was in the ACA. I repeat that: the American 
Health Care Act in no way affects a veteran's ability to access tax 
credits.
  I am disturbed that our colleagues in the minority, Mr. Speaker, 
would assert that it does, in an effort to score political points 
against this legislation. Fear-mongering has no place in this debate or 
where America's veterans are concerned.
  As chairman of the Veterans' Affairs Committee, as a medical doctor, 
and as a veteran myself, ensuring that veterans' health care is 
protected is my highest priority in this Congress, and I would not 
stand for language in this bill or any other bill that would compromise 
a veteran's ability to access care.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from California 
(Ms. Lee) for the purpose of a unanimous consent request.
  (Ms. LEE asked and was given permission to revise and extend her 
remarks.)
  Ms. LEE. Mr. Speaker, I rise to express my opposition to this morally 
bankrupt bill, and I include in the Record a letter of opposition from 
the National Rural Health Association.

              [From the National Rural Health Association]

                Vote NO to the American Health Care Act

       The National Rural Health Association urges a NO vote on 
     the American Health Care Act (AHCA).
       Rural Americans are older, poorer and sicker than other 
     populations. In fact, a January 2017 CDC report pronounced 
     that life expectancies for rural Americans have declined and 
     the top five chronic diseases are worse in rural America. The 
     AHCA does nothing to improve the health care crisis in rural 
     America, and will lead to poorer rural health outcomes, more 
     uninsured and an increase in the rural hospital closure 
     crisis.
       Though some provisions in the modified AHCA bill improve 
     the base bill, NRHA is concerned that the bill still falls 
     woefully short in making health care affordable and 
     accessible to rural Americans. For example, the modified bill 
     contains a decrease in the Medical Expense Deduction 
     threshold from 10% to 5.8% in an attempt to assist Americans 
     between the ages of 50 and 64 who would see their premiums 
     skyrocket under the current plan. However, this deduction is 
     not a credit and therefore would be of little use to low 
     income seniors that are in very low tax brackets or do not 
     pay income tax at all. Additionally, the new amendments to 
     freeze Medicaid expansion enrollment as of Jan. 1, 2018, and 
     reduce the Medicaid per-capita growth rate will 
     disproportionately harm rural Americans.
       The AHCA will hurt vulnerable populations in rural 
     Americans, leaving millions of the sickest, most underserved 
     populations in our nation without coverage, and further 
     escalating the rural hospital closure crisis. According to 
     the Wall Street Journal, the ``GOP health plan would hit 
     rural areas hard.

[[Page H4145]]

     . . . Poor, older Americans would see the largest increase in 
     insurance-coverage costs.'' The LA Times reports ``Americans 
     who swept President Trump to victory--lower-income, older 
     voters in conservative, rural parts of the country--stand to 
     lose the most in federal healthcare aid under a Republican 
     plan to repeal and replace the Affordable Care Act.'' Let's 
     be clear--many provisions in the ACA failed rural America. 
     The lack of plan competition in rural markets, exorbitant 
     premiums, deductibles and co-pays, the co-op collapses, lack 
     of Medicaid expansion, and devastating Medicare cuts to rural 
     providers--all collided to create a health care crisis in 
     rural America. However, it's beyond frustrating that an 
     opportunity to fix these problems is squandered, and instead, 
     a greater health care crisis will be created in rural 
     America.
       Congress has long recognized the importance of the rural 
     health care safety net and has steadfastly worked to protect 
     it. And now, much of the protections created to maintain 
     access to care for the 62 million who live in rural America 
     are in jeopardy. We implore Congress to continue its fight to 
     protect rural patients' access to care. Three improvements 
     are critical for rural patients and providers:
       1. Medicaid--Though most rural residents are in non-
     expansion states, a higher proportion of rural residents are 
     covered by Medicaid (21% vs. 16%).
       Congress and the states have long recognized that rural is 
     different and thus requires different programs to succeed. 
     Rural payment programs for hospitals and providers are not 
     `bonus' payments, but rather alternative, cost-effective and 
     targeted payment formulas that maintain access to care for 
     millions of rural patients and financial stability for 
     thousands of rural providers across the country. Any federal 
     health care reform must protect a state's ability to protect 
     its rural safety net providers. The federal government must 
     not abdicate its moral, legal, and financial responsibilities 
     to rural, Medicaid eligible populations by ensuring access to 
     care.
       Any federal health care reform proposal must protect access 
     to care in Rural America, and must provide an option to a 
     state to receive an enhanced reimbursement included in a 
     matching rate or a per capita cap, specifically targeted to 
     create stability among rural providers to maintain access to 
     care for rural communities. Enhancements must be equivalent 
     to the cost of providing care for rural safety net providers, 
     a safeguard that ensures the enhanced reimbursement is 
     provided to the safety net provider to allow for continued 
     access to care. Rural safety net providers include, but not 
     limited to, Critical Access Hospitals, Rural Prospective 
     Payment Hospitals, Rural Health Clinics, Indian Health 
     Service providers, and individual rural providers.
       2. Market Reform--Forty-one percent of rural marketplace 
     enrollees have only a single option of insurer, representing 
     70 percent of counties that have only one option. This lack 
     of competition in the marketplace means higher premiums. 
     Rural residents average per month cost exceeds urban ($569.34 
     for small town rural vs. $415.85 for metropolitan).
       Rural Americans are more likely to have obesity, diabetes, 
     cancer, and traumatic injury; they are more likely to 
     participate in high risk health behaviors including smoking, 
     poor diet, physical inactivity, and substance abuse. Rural 
     Americans are more likely to be uninsured or underinsured and 
     less likely to receive employer sponsored health insurance. 
     Rural communities have fewer health care providers for 
     insurers to contract, with to provide an adequate network to 
     serve the community.
       Any federal health care reform proposal must address the 
     fact that insurance providers are withdrawing from rural 
     markets. Despite record profit levels, insurance companies 
     are permitted to cherry pick profitable markets for 
     participation and are currently not obliged to provide 
     service to markets with less advantageous risk pools. 
     Demographic realities of the rural population make the market 
     less profitable, and thus less desirable for an insurance 
     company with no incentive to take on such exposure. In the 
     same way that financial service institutions are required to 
     provide services to underserved neighborhoods, profitable 
     insurance companies should be required to provide services in 
     underserved communities.
       3. Stop Bad Debt Cuts to Rural Hospitals--Rural hospitals 
     serve more Medicare patients (46% rural vs. 40.9% urban), 
     thus across-the-board Medicare cuts do not have across the 
     board impacts. A goal of the ACA was to have hospital bad 
     debt decrease significantly.
       However, because of unaffordable health plans in rural 
     areas, rural patients still cannot afford health care. Bad 
     debt among rural hospitals has actually increased 50% since 
     the ACA was passed. According to MedPAC ``Average Medicare 
     margins are negative, and under current law they are expected 
     to decline in 2016'' has led to 7% gains in median profit 
     margins for urban providers while rural providers have 
     experienced a median loss of 6%.
       If Congress does not act, all the decades of efforts to 
     protect rural patients' access to care, could rapidly be 
     undone. The National Rural Health Association implores 
     Congress to act now to protect rural health care across the 
     nation.
  Mr. PALLONE. Mr. Speaker, I want to remind my colleague from 
Tennessee that his vote could increase premiums with breast cancer in 
Tennessee by $38,550 per year.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Michigan 
(Mrs. Dingell).
  Mrs. DINGELL. Mr. Speaker, I rise today in strong opposition to this 
misguided legislation to repeal the Affordable Care Act.
  This vote might be the single most important issue our Congress deals 
with. It literally means life or death for too many people in our 
country.
  What we vote on today is ultimately a reflection of our values as a 
nation. I believe that we have a moral responsibility to take care of 
the most vulnerable among us. The nuns taught me that. The Bible 
teaches us that. They are the sick, the poor, the elderly. This 
dangerous bill does nothing to protect them. In fact, it will do more 
harm to our most vulnerable.
  There are 129 million Americans who suffer from a preexisting 
condition. They are our neighbors, our friends, and, for some, our 
family. They are the people attending their townhall meetings.
  For me, I am a caregiver. I spend more time at the hospital and with 
the doctors than I want to. Person after person comes up to me and 
tells me their story and begs me not to lose their insurance. Healthy 
Michigan let them go to the doctor for the first time.
  The Affordable Care Act made a guarantee that someone with a 
preexisting condition could not be charged more than healthy people and 
that coverage would be available to all.
  Please vote against this shameful bill.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Tennessee (Mrs. Black), the chairman of the Budget Committee.
  Mrs. BLACK. Mr. Speaker, I am always amazed when I start hearing 
conversations about the Affordable Care Act and how it is working so 
well today.
  I want to talk about two situations in my home State of Tennessee.
  When the Affordable Care Act went into place in the State of 
Tennessee, we had a risk pool. The risk pool covered about 28,000 
people. They were happy with their care, they were happy with their 
providers, and they were happy with the cost. It was patient centered. 
They determined what best fit their needs. These were people with 
preexisting conditions, happy with where they were.
  In 1 day, because the Federal Government said, You don't meet this 
and you don't meet that and you don't meet this, they lost their 
insurance. They were in the marketplace.
  I want to tell you about two situations that are very close to me, 
but they only represent a number of the many calls that I get in my 
office.
  One is a good friend of mine who has lupus. She went on the 
marketplace. For the first year, she did pretty good. Her premiums were 
pretty low; her deductible was reasonable. But here is what she found: 
she couldn't keep her doctor.
  Can you imagine someone who has had lupus for a number of years, it 
is being controlled, and now she is told she cannot keep her doctor? 
She had to find other doctors. She was not happy with that because she 
had a relationship. They didn't use the same treatment and care that 
she had received before. So she has not felt very healthy.
  In the meantime, every year that it is renewed, she calls me to say: 
My premiums have gone up, my deductibles have gone up, and now it is 
more than what I was paying before when I liked what I had and I 
couldn't keep it, opposite of what the President told everyone: If you 
like what you have, you can keep it.
  The second one is someone who has myasthenia gravis. Again, on that 
same risk pool. She lost her opportunity to get the medication that she 
was receiving, an IV medication. She has myasthenia gravis. She was 
very controlled, able to work, living a healthy lifestyle.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. BURGESS. Mr. Speaker, I yield an additional 1 minute to the 
gentlewoman.
  Mrs. BLACK. She lost her opportunity to have that medication because 
that medication was $400 a month, now

[[Page H4146]]

it is $3,400 month, and no longer can she get her medication.
  When the other side talks about how wonderful this system is, I 
implore them to come to our State and talk to the people in our State.
  I am a registered nurse. I know what it is like to take care of 
people who have healthcare conditions who need to be in a risk pool. 
But let's do it the right way. Let's give it to our States. Let's allow 
this now to be used in a way that is patient-centered, the way it was 
working in my home State of Tennessee.
  Mr. Speaker, I support this bill, and I am looking forward to the 
vote later on this afternoon.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Tennessee that 
her vote will take away protections for 1.265 million in her State with 
preexisting conditions.
  Mr. Speaker, I yield 45 seconds to the gentleman from Maryland (Mr. 
Sarbanes).
  Mr. SARBANES. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, President Trump and the Republicans are looking for a 
win. They want to put points on the scoreboard. But why would you want 
to win by taking healthcare coverage away from 24 million Americans? 
Why would you consider it a victory to raise premiums and copayments 
and deductibles on millions of Americans, including millions of older 
Americans? Why would you view it as a success to eliminate protections 
for preexisting conditions?
  If I could vote against this bill 100 times, I would do it. If I 
could vote against it 1,000 times for the thousands of my constituents 
that will be hurt by this bill, I would.
  It is wrong, it is immoral, and it is inhumane.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Kentucky (Mr. Guthrie), the vice chairman of the Health Subcommittee on 
the Energy and Commerce Committee.
  Mr. GUTHRIE. Mr. Speaker, I thank the chairman for yielding.
  Mr. Speaker, what I want to talk about is what is underlying in this 
bill in the traditional reform in Medicaid.
  Medicaid currently costs State and Federal Governments $600 billion. 
It is estimated in 10 years--a decade--to cost a trillion dollars. It 
is a system that is set up to implode on itself.
  So we want to fix the problem before we get to the critical point 
where it is going to implode. Let's fix it now, and let's make it 
right.
  What we do is allow States to have the same money they had in 2016--
the exact same money--with growth. The growth would be the CPI, 
medical, and, in some categories, plus one. They also have growth in 
demographics. We have some people who retire to other States. They have 
a concern. What if I am from a State where somebody lives in an area 
and then they move to my State when they are older and typically cost 
more in the Medicaid system? We adjust for that. It is in the per 
capita allotment. As they move, they would transfer. It is not a 
traditional block grant, unless the State chooses to do so.
  We are here reforming an entitlement program for the first time since 
the 1990s. It is a very sound, solid way, and a way that preserves and 
protects the program and prevents the program from imploding on itself 
within a decade.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from Kentucky that 
his vote for the healthcare bill will take away protections for 881,000 
people with preexisting conditions in Kentucky.
  Mr. Speaker, I yield 1 minute to the gentleman from California (Mr. 
Ruiz).
  Mr. RUIZ. Mr. Speaker, this bill is worse than a sham. This bill is 
worse than a sugar pill. This bill is downright ugly. It is poison. As 
an emergency medicine doctor, I urge you to do no harm. I urge 
everybody to do no harm.
  Let's be clear: a vote for this bill is a vote for 24 million people 
to lose their insurance. A vote for this bill is to add an age tax to 
those 55 years old and older. A vote for this bill is raise out-of-
pocket costs for everyone, with less coverage. A vote for this bill is 
to take away guarantees for emergency care, medicine, mental health, 
and maternity care. A vote for this bill is to allow private health 
insurance companies to drop patients who have a preexisting illness.
  How, you may ask? Let's say I see a patient with diabetes who doesn't 
have health insurance. A private health insurance company can say: No, 
we are not going to cover you. Why don't you go to the high-risk, high-
cost State insurance pool that is way too expensive, with no guarantees 
that they will cover what they need. Therefore, they won't be able to 
afford it. They won't have coverage. They are going to go into 
financial ruin. All of this is in order to give $6 billion in tax cuts 
to the wealthiest.
  I urge everybody to vote ``no.''
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Oregon (Mr. Walden), the chairman of the full Committee on Energy and 
Commerce.
  Mr. WALDEN. Mr. Speaker, I thank our colleagues who have worked so 
hard on this legislation to try and rescue these failing insurance 
markets.
  We learned yesterday, I think most of Iowa now will not have a single 
insurer left on the exchanges. If you are one of the people out there 
in the one-out-of-three counties where people only have one option for 
insurance, what we are trying to do here is fix this market so you 
actually have insurance to cover you.
  We believe that in going forward with this piece of legislation not 
only do we give more flexibility to States to innovate, they care about 
the people in their States. I know my home State of Oregon does. Yet 
they are facing a shortfall right now that this legislation would 
provide over $320 million to help fill.
  One of their proposals is to kick 350,000 people off of Medicaid. 
This would help fill the gap: $320 million in the next 2 years to fill 
an $882 million shortfall they have.
  But this is a problem across the country. What we are trying to do 
here is reform ObamaCare, the Affordable Care Act, in a way that will 
work going into the future. Otherwise, people are going to be left with 
not only enormous rate increases in the premiums, but also you have 
seen an explosion in the cost of what they have to pay out of pocket.
  I have had people in my district say: Look, I am outside of that area 
where I get a subsidy, and I am paying full price. Our premiums have 
gone up 50 percent in the last 2 years. My options have gone down from 
four or five to maybe one or two, maybe three, and it is getting worse. 
They are threatening to pull out. My out-of-pocket costs are now so 
high, I am paying for something I can't even afford to use.
  We are trying to fix and rescue this market and bring people in.
  You hear all these numbers State by State. I am not buying into that 
at all. They don't understand what our bill does. We are giving States 
authority, we are giving protections for people, and we are going to 
get this straightened out once and for all so that we have an insurance 
market that works, but, more importantly, that we have a healthcare 
system that people can afford and that we can get quality health care 
when they see a doctor, between them and their doctor, without a 
bureaucrat in between.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from Michigan 
(Mrs. Lawrence) for the purpose of a unanimous consent request.
  (Mrs. LAWRENCE asked and was given permission to revise and extend 
her remarks.)
  Mrs. LAWRENCE. Mr. Speaker, I rise today to express my opposition to 
this horrible bill, and I include in the Record a letter in opposition 
from the Children's Hospital Association.

                              Children's Hospital Association,

                                   Washington, DC, March 15, 2017.
     Hon. Orrin Hatch,
     Chairman, Committee on Finance, U.S. Senate, Washington, DC.
     Hon. Ron Wyden,
     Ranking Member, Committee on Finance, U.S. Senate, 
         Washington, DC.
     Hon. Greg Walden,
     Chairman, Committee on Energy and Commerce, House of 
         Representatives, Washington, DC.
     Hon. Frank Pallone,
     Ranking Member, Committee on Energy and Commerce, House of 
         Representatives, Washington, DC.
       Dear Chairmen Hatch and Walden: On behalf of our nation's 
     children's hospitals and the patients and families they 
     serve, we believe the American Health Care Act (AHCA) in its 
     current form is a setback to child health on a national 
     level. Over 30 million children receive their health care 
     coverage through Medicaid. The legislation as written

[[Page H4147]]

     cuts the budget, coverage, and benefits for the care for 
     children, many of whom have significant health care needs, 
     including children with disabilities.
       Children's hospitals have identified several provisions in 
     the AHCA that create serious concerns about the bill as 
     passed by the House Energy and Commerce Committee. Foremost 
     among these concerns is that the bill would cut the health 
     care budget for children by converting the Medicaid program 
     to a per-capita cap system beginning in 2020. This limits 
     future funding for the states and risks significant 
     reductions in the Medicaid budgets providing care for over 30 
     million children. The current Medicaid entitlement financing 
     structure allows for greater certainty for children in the 
     Medicaid program and shifting to a capped environment risks 
     undermining the current health care available to children.
       We are alarmed children's health care financing is not 
     considered and protected in the AHCA, and that children are 
     exposed to equal funding risk in the Congressional Budget 
     Office (CBO) estimates that AHCA will reduce overall Medicaid 
     funding by $880 billion or 25%. Medicaid is the largest payer 
     for children's health care in the nation and cuts of this 
     magnitude will have a severe negative impact on children's 
     health care. There are also discrete program changes 
     envisioned in the AHCA posing detrimental effects to 
     children's access to health care. Eligibility policy changes 
     in the bill risk reducing or delaying access to Medicaid 
     coverage. We are concerned by CBO's projections that Medicaid 
     enrollment will substantially decrease under the AHCA and the 
     absence of information on the impact on children specifically 
     suggests that additional examination of these issues is 
     needed.
       We support maintaining Medicaid as an entitlement for 
     children as well as retaining essential elements of the 
     program. Every child in America should have access to high 
     quality health care and Medicaid is critical to this aim. 
     Research shows providing Medicaid coverage for children is a 
     smart investment for the nation, resulting in better health 
     outcomes for children into their adult lives and bringing 
     long-term returns for the country.
       Children's hospitals cannot support any bill that does not 
     safeguard funding, coverage and benefits for children. With 
     respect to the AHCA, we call on lawmakers to protect kids and 
     recommend, at a minimum, the following:
       We must not cut funding for children's care under a per 
     capita cap. Children are already funded at the lowest per 
     beneficiary levels, and ensuring sufficient funding for 
     children's health care into the future is absolutely 
     essential. Accomplishing this under the current proposal 
     requires clear identification of spending for all children, 
     including those eligible based on disability, and exempting 
     funds spent on children from a ``claw back'' on any spending 
     that exceeds per capita cap target expenditures. We believe 
     spending on all children should be protected from recoupment 
     in the following year. This is critical to ensuring states do 
     not have incentives to restrict children's access to 
     medically necessary care.
       Ensure all funding for children, including blind and 
     disabled children, is clearly identified. Accurate 
     information on Medicaid spending is vital to evaluating the 
     program's effectiveness for children and holding states 
     accountable for the delivery of services. We believe all 
     children, including blind and disabled children, should be 
     included in a single children's 1903A enrollee category and 
     the per capita cap for children should be adjusted 
     accordingly to reflect the higher expenses of children with 
     disabilities. Children are a separate and distinct population 
     from adults. Funding dedicated to children must be 
     identifiable, allowing for an accurate picture of the federal 
     and state investment in kids. This is an important part of 
     ensuring accountability and the availability of sufficient 
     resources to address children's health care needs. We believe 
     it is important to consider protections preventing diversion 
     of resources specifically intended for children. As we work 
     with state governments to innovate and improve care delivery, 
     the nation's pediatric providers are in a better position to 
     help states achieve their goals if all kids are in a common 
     eligibility category.
       Continue requirements that all children receive pediatric-
     specific benefits providing medically necessary care 
     determined by their physicians. The current Medicaid 
     structure includes important protections for all children and 
     ensures they have access to medically-necessary care. It is 
     essential that Congress includes language guaranteeing 
     continued access to pediatric-specific services provided 
     under the Early and Periodic Screening Diagnostic and 
     Treatment (EPSDT) benefit.
       Maintain Medicaid coverage levels for children and protect 
     them from potential loss of coverage or delays in 
     eligibility. Changes to eligibility, such as ending 
     hospitals' ability to make presumptive eligibility 
     determinations, limiting retroactive coverage, or reducing 
     children's Medicaid mandatory eligibility levels, directly 
     risk children's coverage and should not be included.
       Remove the provision in the bill eliminating hospital 
     presumptive eligibility authority. Hospital presumptive 
     eligibility authority allows hospitals to temporarily enroll 
     children, pregnant women, and other individuals in Medicaid 
     until their full enrollment determination can be made. This 
     means earlier access to needed care for Medicaid eligible 
     children.
       Remove the provision in the bill repealing the ability of 
     states to provide retroactive eligibility up to three months 
     prior to the month of application, as allowed under current 
     law. Ensuring retroactive coverage of benefits under Medicaid 
     is very important for children, especially children with 
     complex medical conditions. Without this provision, it will 
     be challenging for families who incur high levels of expense 
     prior to their Medicaid-eligible child being enrolled in the 
     program.
       Remove the provision in the bill reducing mandatory 
     eligibility levels for children age 6-18 from 133 percent of 
     federal poverty level (FPL) to 100 percent of FPL. All other 
     children are required to be covered by Medicaid up to 133 
     percent of the FPL.
       Thank you again for the opportunity to provide comment on 
     this legislation. We look forward to working with you in this 
     Congress to at least maintain the benefits children have 
     today, and to hopefully strengthen health care for children 
     into the future.
           Very best regards,

                                                Mark Wietecha,

                                                President and CEO,
                                  Children's Hospital Association.

  Mr. PALLONE. Mr. Speaker, I remind the chairman that his vote for the 
healthcare bill will take away protections for 654,000 people with 
preexisting conditions in Oregon.
  Mr. Speaker, I yield 1 minute to the gentlewoman from Washington (Ms. 
Jayapal).
  Ms. JAYAPAL. Mr. Speaker, I thank the gentleman for leading and for 
his leadership.
  Mr. Speaker, let's be very clear about where we are with TrumpCare 
2.0.
  This bill still strips 24 million Americans of health care, cuts $880 
billion from Medicaid, and increases premiums for the majority of 
Americans. It still has an age tax if you are 50 to 64 years old, and 
cuts maternity care and coverage for substance abuse disorders.
  It still gives $1 trillion in tax cuts to the wealthiest 
millionaires, billionaires, and corporations on the backs of working 
people who will pay more and get less.
  TrumpCare 2.0 adds insult to injury because my Republican colleagues 
would like you to believe that they are going to cover preexisting 
conditions. That is just not true.
  American people, be clear: this will not cover preexisting 
conditions, and 133 million Americans with those preexisting conditions 
will suffer. There are kids like James Kish, an 8-year-old in my 
district who has a brain tumor and literally stands to die if this bill 
passes.
  Mr. Speaker, hundreds across this country are calling our offices and 
weeping. We should all weep that this bill is coming to the floor. We 
should vote ``no.''

                              {time}  1215

  Mr. BURGESS. Mr. Speaker, I yield 20 seconds to the gentleman from 
Oregon.
  Mr. WALDEN. Mr. Speaker, I have to say that the information that we 
are being told, even The New York Times has characterized some of it as 
being misleading, and it is. When you say Oregonians are going to 
suddenly be thrown out, that is not true on preexisting conditions 
because there is no waiver request. You are just making that stuff up. 
I dispute it. It is misleading. It is wrong. It is fear-mongering, and 
I am sorry it is happening on this floor.
  Mr. PALLONE. Mr. Speaker, I just want to remind my chairman that he 
represents more people on Medicaid expansion than any Republican in the 
country, and this bill ends Medicaid expansion.
  Mr. Speaker, I yield 1 minute to the gentlewoman from Ohio (Ms. 
Kaptur).
  Ms. KAPTUR. Mr. Speaker, TrumpCare is another false promise. 
Actually, it is musical chairs. Millions of Americans will be left out 
and priced out, especially the sick, the old, the pregnant, and the 
mentally ill. Health insurance means life or death.
  In this concoction, who is eligible? How much will it cost? Who will 
be left out?
  There is no budget score from the Congressional Budget Office. 
Republicans aren't guaranteeing affordable coverage. Everybody knows 
even a one-word change in your insurance policy can make a gigantic 
difference in your coverage.
  Why not give Americans a chance to calculate the bill's true cost and 
how it will impact them?
  As a result of the Affordable Care Act, 1 million Ohioans now have 
health

[[Page H4148]]

insurance who didn't have it before. Here we are at the end of our long 
voting week with a major proposal that will rip away the health 
insurance benefits or make them unaffordable for millions of Americans. 
Musical chairs is not the way to run the people's House nor the life-
and-death affairs of a great nation. TrumpCare sets up a cruel game of 
musical chairs. Shame, shame, shame.
  Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from 
Kentucky (Mr. Guthrie), the vice chairman of the Subcommittee on 
Health.
  Mr. GUTHRIE. Mr. Speaker, I am surprised that my friends on the other 
side are defending the ObamaCare age tax, which is a tax on young 
people. I am the right demographic for it.
  This is how it works: people from age 26 to 34 pay more so people 
from age 50 to 64 pay less.
  Think about this: I am 53. In 3 years, I will be 56, my daughter will 
be 26. What I am asking her to do and what we are asking her to do if 
we don't repeal this is, as you are wanting to buy a house, get 
married--she got married--buy a house, start a family, get her family 
moving forward, we are going to say: But we want you to pay more for 
your health care so I can pay less.
  That is what they are doing. They are having parents have their 
children pay more so they can pay less. With all of us, I think we want 
our children, as they start their families, start their life, to have 
more breaks, not put another burden on them.
  I defend the fact that we are giving tax relief to young people, for 
people from age 26 to 34, who can least afford the premiums that we are 
putting on them.
  Mr. PALLONE. Mr. Speaker, may I inquire as to the time that remains 
on both sides?
  The SPEAKER pro tempore. The gentleman from New Jersey has 2\3/4\ 
minutes remaining. The gentleman from Texas has 3 minutes remaining.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from 
Rhode Island (Mr. Cicilline).
  Mr. CICILLINE. Mr. Speaker, this is the cruelest and most immoral 
thing I have seen the Republican Party do to the American people. Tens 
of thousands of Americans will die if this bill passes. That is a fact. 
Republicans have been deceiving the American people for the last 8 
years. They don't care about working people, and this bill proves it. 
They care about insurance companies and drug companies that fund their 
campaigns. They care about the millionaires and billionaires who get 
huge tax cuts in this bill. Don't try to tell me that they care about 
factory and construction workers who will be hurt by this bill. Don't 
try to tell me that they care about single moms who won't be able to 
put food on the table after you pass this bill. Don't try to tell me 
that they care about cancer survivors who are going to pay $140,000 
more for health insurance.
  I don't know how anyone can look their constituents in the eye if 
they vote for this bill. Shame on you if you do. If you vote for this 
bill, there will come a day when you will have to answer for your vote, 
when you will have to look a friend, a family member in the eye, 
someone who is sick or dying, and say: I did this to you.
  Don't do it. Vote ``no.''
  The SPEAKER pro tempore. Members are reminded once again to direct 
their remarks to the Chair.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
South Carolina (Mr. Rice).
  Mr. RICE of South Carolina. Mr. Speaker, I stand in support of the 
American people today who are being dragged down by this failing 
disaster called ObamaCare. Since I first got to Congress, I have 
consistently heard from people across the Seventh District of South 
Carolina who have been negatively affected by ObamaCare.
  We were told: If you like your plan, you could keep it.
  We were told: Your premiums would go down by $2,500 per family.
  We were told it would provide more choice. But what we have seen is 
exactly the opposite. 232,000 South Carolinians' plans were canceled, 
premiums have increased by double digits every year and are up by 28 
percent this year. There is only one insurer left in South Carolina, 
and they are threatening to pull out. The law is failing miserably and 
getting worse.

  This bill repeals harmful ObamaCare taxes across the board that drove 
up healthcare costs and transitions health care to a more competitive, 
patient-centered insurance market. There are still fixes that need to 
be made to further improve health care, but this is a dramatic move 
forward from where we are today and the first step in moving America's 
health care from an unsustainable system to a sustainable one.
  Mr. PALLONE. Mr. Speaker, I remind my colleague from South Carolina 
that his vote for the healthcare bill will take away protections for 
822,000 people with preexisting conditions in South Carolina.
  Mr. Speaker, I yield 45 seconds to the gentlewoman from Florida (Ms. 
Wasserman Schultz).
  Ms. WASSERMAN SCHULTZ. Mr. Speaker, I rise today to condemn this 
abhorrent legislation that will rip away protections from millions of 
Americans. I am a breast cancer survivor. President Trump and our 
Republican colleagues promised Americans like me that we would not be 
discriminated against based on our preexisting conditions.
  I am not sure if any Republicans actually know what it is like to 
live every single day of your life waiting for the other shoe to drop, 
but with this bill, you yank that peace of mind that we have with the 
Affordable Care Act out from under us.
  This bill would allow States to segregate sick people into separate, 
inferior coverage and leave individuals exposed to catastrophic health 
costs, benefit exclusions, and waiting lists. High-risk pools spin sick 
people into a death spiral. Premiums go ever higher and coverage is 
spotty.
  I can only hope that my colleagues come to their senses before 
inevitably handing so many Americans a death sentence. Make no mistake, 
people will die as a result of this bill.
  Mr. BURGESS. Mr. Speaker, may I inquire as to the time remaining.
  The SPEAKER pro tempore. The gentleman from Texas has 1\1/2\ minutes 
remaining. The gentleman from New Jersey has \3/4\ minute remaining.
  Mr. BURGESS. Mr. Speaker, I yield myself 1 minute.
  I do want to take a minute today to thank the superior team we have 
in the House Legislative Counsel. They have put in many man hours and 
woman hours to draft this bill that is being considered here in the 
House today. Specifically I want to thank Ed Grossman, Jessica Shapiro, 
Michelle Vanek, and Jesse Cross for their devotion to the people of the 
United States in helping us draft this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield my remaining time to the 
gentlewoman from Illinois (Ms. Kelly).
  Ms. KELLY of Illinois. Mr. Speaker, how tragic it is that before 
House Republicans skip town, they will steal from Medicare, pass an age 
tax on older Americans, say that children with autism are a preexisting 
condition, and tell folks: If you have diabetes, you are paying $5,600 
more.
  This morning, I heard from many hospitals, doctors, and nurses across 
Illinois. They know what families need to be taken care of and to be 
healthy. They do not believe that stripping 24 million Americans of 
their health insurance is in the best interests of our national health.
  To my eight Illinois colleagues on the Republican side of the aisle, 
if you vote ``yes'' on this bill, the eight of you own its aftermath in 
our State; you own the 47,000 jobs that you will kill; you own the 
health of the million-plus Illinoisans who will be stripped of their 
health insurance.
  Let's kill this horrific bill and work together to make health 
insurance affordable and accessible for all.
  The SPEAKER pro tempore. The Chair again reminds Members to direct 
their remarks to the Chair.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, we are here today to correct a technical problem that 
exists with trying to draft to Senate rules with the House legislation. 
Recognizing the problem, the gentlewoman from Arizona (Ms. McSally) has 
introduced a straightforward and practical bill to fix the problem. It 
is a simple 2-page bill that, when the American

[[Page H4149]]

Health Care Act becomes law, Members of Congress and congressional 
staff will be treated the same way as every other citizen. That is only 
right, and it is only proper.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 308, the previous question is ordered on 
the bill.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BURGESS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________